The novel lipid delivery system of amphotericin B: drug profile and relevance to clinical practice.
OBJECTIVE
To review the drug profile and nursing implications associated with the new lipid amphotericin preparations.


METHODS
Published articles, abstracts, professional communications, drug manufacturer prescribing information, and personal experience.


RESULTS
Three lipid amphotericin B (AmB) preparations have been approved by the U.S. Food and Drug Administration (FDA). The first agent, amphotericin B lipid complex (Abelcet, Liposome Co., Princeton, NJ), a ribbon-like structure, was approved in November 1995 for the treatment of aspergillosis in patients who are refractory to or intolerant of conventional amphotericin B therapy and for invasive fungal infections. In November 1996, amphotericin B cholesteryl sulfate complex for injection (Amphotec, Sequus Pharmaceuticals, Menlo Park, CA), a second preparation composed of a disc-like structure, received FDA approval for the treatment of invasive aspergillosis in patients in whom renal impairment or unacceptable toxicity precludes the use of conventional AmB therapy and in patients in whom prior AmB therapy has failed. Amphotec frequently is referred to as amphotericin B colloidal dispersion (ABCD). The third formulation, a liposomal preparation composed of vesicles, liposomal amphotericin B or L-AmB (AmBisome, Fujisawa USA, Inc., Deerfield, IL, and Nexstar Co., Boulder, CO) recently received FDA approval for three indications. All of these preparations accumulate in organs of the reticuloendothelial system as opposed to the kidneys. Further studies of lipid AmB are needed to help clarify the usefulness of each AmB preparation. The most common side effects of lipid AmB preparations are chills and fever.


CONCLUSIONS
Lipid-based AmB preparations are well-tolerated treatments with mild to moderate side effects. These preparations have some advantages over conventional AmB.


CONCLUSIONS
Nurses in clinical settings can focus on staff and patient education, including identification and management of side effects associated with the lipid-based AmB preparations. Patient-care concerns include appropriate patient selection, dosing and administration issues, and the prevention, early identification, and management of toxicities.
Rust
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University of Pittsburgh Cancer Institute, PA, USA.
Jameson
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D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D002986:Clinical Trials as Topic; D004337:Drug Carriers; D004338:Drug Combinations; D016503:Drug Delivery Systems; D006801:Humans; D008081:Liposomes; D010347:Patient Care Planning; D010713:Phosphatidylcholines; D010715:Phosphatidylglycerols
D000935:Antifungal Agents; D004337:Drug Carriers; D004338:Drug Combinations; D008081:Liposomes; D010713:Phosphatidylcholines; D010715:Phosphatidylglycerols; C068538:liposomal amphotericin B; D000666:Amphotericin B